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1.
Catheter Cardiovasc Interv ; 96(4): E423-E431, 2020 10 01.
Article in English | MEDLINE | ID: mdl-32170905

ABSTRACT

BACKGROUND: The use and clinical outcomes of fractional flow reserve (FFR)-guided revascularization in patients presenting with either stable coronary artery disease (CAD) or an acute coronary syndrome (ACS) in daily clinical practice are uncertain. OBJECTIVE: To prospectively characterize the frequency of the change in treatment plan when FFR is performed compared to the initial decision based on angiography alone and procedure-related outcomes. METHODS: We undertook a prospective, multicenter, multinational, open-label, observational study of coronary physiologic measurements during clinically indicated coronary angiography. The treatment plan, including medical therapy, PCI or CABG, was prospectively recorded before and after performing FFR. Adverse events were pre-defined and prospectively recorded per local investigators (PRESSUREwire; ClinicalTrials.gov identifier: NCT02935088). RESULTS: Two thousand two hundred and seventeen subjects were enrolled in 70 hospitals across 15 countries between October 2016-February 2018. The mean FFR (all measurements) was 0.84. The treatment plan based on angiography-alone changed in 763/2196 subjects (34.7%) and 872/2931 lesions (29.8%) post-FFR. In the per-patient analysis, the initial treatment plan based on angiography versus the final treatment plan post-FFR were medical management 1,350 (61.5%) versus 1,470 (66.9%) (p = .0017); PCI 717 (32.7%) versus 604 (27.5%) (p = .0004); CABG 119 (5.4%) versus 121 (5.5%) (p = .8951). The frequency of intended revascularization changed from 38.1 to 33.0% per patient (p = .0005) and from 35.5 to 29.6% per lesion (p < .0001) following FFR. CONCLUSIONS: On an individual patient basis, use of FFR in everyday practice changes the treatment plan compared to angiography in more than one third of all-comers selected for physiology-guided managements. FFR measurement is safe, providing incremental information to guide revascularization decisions.


Subject(s)
Cardiac Catheterization , Coronary Artery Disease/diagnosis , Coronary Vessels/physiopathology , Fractional Flow Reserve, Myocardial , Aged , Cardiovascular Agents/therapeutic use , Clinical Decision-Making , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease/physiopathology , Coronary Artery Disease/therapy , Coronary Vessels/diagnostic imaging , Female , Humans , Male , Middle Aged , Percutaneous Coronary Intervention , Predictive Value of Tests , Prospective Studies , Registries , Time Factors , Treatment Outcome
2.
Sci Adv ; 5(9): eaaw0672, 2019 09.
Article in English | MEDLINE | ID: mdl-31548981

ABSTRACT

NIR-II fluorescence imaging greatly reduces scattering coefficients for nearly all tissue types at long wavelengths, benefiting deep tissue imaging. However, most of the NIR-II fluorophores suffer from low quantum yields and/or short circulation time that limit the quality of NIR-II imaging. Here, we engineered a supramolecular assembly of protein complex with lodged cyanine dyes to produce a brilliant NIR-II fluorophore, providing a NIR-II quantum yield of 21.2% with prolonged circulation time. Computational modeling revealed the mechanism for fluorescence enhancement and identified key parameters governing albumin complex for NIR-II fluorophores. Our complex afforded high-resolution microvessel imaging, with a 3-hour imaging window compared to 2 min for free dye alone. Furthermore, the complexation strategy was applied to an antibody-derived assembly, offering high-contrast tumor imaging without affecting the targeting ability of the antibody. This study provides a facile strategy for producing high-performance NIR-II fluorophores by chaperoning cyanine dyes with functional proteins.


Subject(s)
Contrast Media , Fluorescent Dyes , Neoplasms, Experimental , Optical Imaging , Serum Albumin, Bovine , Animals , Cattle , Contrast Media/chemistry , Contrast Media/pharmacokinetics , Contrast Media/pharmacology , Fluorescent Dyes/chemistry , Fluorescent Dyes/pharmacokinetics , Fluorescent Dyes/pharmacology , Mice , Mice, Inbred BALB C , Mice, Nude , Neoplasms, Experimental/blood supply , Neoplasms, Experimental/diagnostic imaging , Serum Albumin, Bovine/chemistry , Serum Albumin, Bovine/pharmacokinetics , Serum Albumin, Bovine/pharmacology
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